There are many medication options for treating rheumatoid arthritis (RA). This includes DMARDs, biologics, immunosuppressants, and JAK inhibitors. Your doctor can recommend the best treatment for you.

The main goal of rheumatoid arthritis (RA) drugs is to block inflammation to help prevent joint damage. Read on to learn about the medication options for RA.

DMARDs

Disease-modifying antirheumatic drugs (DMARDs) are used to decrease inflammation. This may be one of the first drugs you are prescribed after being diagnosed with RA.

Unlike other medications that temporarily ease pain and inflammation, DMARDs can slow the progression of RA. This means you may have fewer symptoms and less damage over time.

The most common DMARDs used to treat RA include:

Biologics

Biologics are injectable drugs. They work by targeting the parts of the immune system responsible for inflammation.

Doctors prescribe biologics when DMARDs alone aren’t enough to treat RA symptoms.

Biologics aren’t recommended for people with compromised immune systems or an infection. This is because they can raise the risk of serious infections.

Some common biologics include:

Your doctor may prescribe JAK inhibitors if DMARDs or biologics aren’t treating your RA as well. These medications work by blocking enzymes that play a role in the inflammatory and immune responses of RA. They are taken orally.

JAK inhibitors include:

Before starting a JAK inhibitor, ask your doctor to ensure you’re up to date on all immunizations, including prophylactic zoster vaccinations (shingles vaccine).

Common side effects of these drugs include:

  • upper respiratory infections, like sinus infections or the common cold
  • congested nose
  • runny nose
  • sore throat
  • influenza
  • shingles
  • cystitis (urinary bladder infection)

Acetaminophen is available over the counter (OTC) without a prescription. It comes as an oral drug and a rectal suppository.

Other drugs are much more effective at reducing inflammation in RA, as acetaminaphen doesn’t have any anti-inflammatory activity.

This drug carries the risk of serious liver problems, including liver failure. Only take one drug that contains acetaminophen at a time.

NSAIDs are among the most commonly used RA drugs. They are effective at relieving pain and, at higher doses, they can prevent inflammation.

Some people use OTC NSAIDs. However, stronger NSAIDs are available with a prescription.

Side effects of NSAIDs include:

  • stomach irritation
  • stomach ulcers
  • stomach bleeding
  • kidney problems
  • high blood pressure
  • fluid retention

Let your doctor know if you have a history of:

  • kidney or liver problems
  • stomach problems, such as reflux or ulcers
  • inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
  • cardiovascular problems (high blood pressure, heart failure, past stroke or a heart attack)

You should also let your doctor know if you take blood thinners or corticosteroids, or if you are pregnant or breastfeeding.

Ibuprofen (Advil, Motrin IB, Nuprin)

OTC ibuprofen is the most common NSAID. Unless instructed by your doctor, don’t use ibuprofen for more than several days at a time.

Ibuprofen is available in prescription strengths as well. In prescription versions, the dosage is higher. Ibuprofen may also be combined with opioids, another type of pain drug.

An example of a prescription combination drug is ibuprofen/oxycodone (Combunox).

Naproxen sodium (Aleve)

Naproxen sodium is an OTC NSAID. It’s often used as an alternative to ibuprofen. Prescription versions of this drug offer stronger dosages.

Aspirin (Bayer, Bufferin, St. Joseph)

Aspirin is an oral pain reliever. It’s used to treat mild pain, fever, and inflammation. It can also be used to prevent heart attack and stroke.

Prescription NSAIDs

When OTC NSAIDs don’t relieve your RA symptoms, your doctor may prescribe a prescription NSAID. These are oral drugs. The most common options include:

  • celecoxib (Celebrex)
  • ibuprofen (prescription strength)
  • nabumetone (Relafen)
  • naproxen (Naprosyn)
  • naproxen sodium (Anaprox)
  • piroxicam (Feldene)

Other NSAIDs include:

  • diclofenac (Voltaren, Diclofenac Sodium XR, Cataflam, Cambia)
  • diflunisal
  • indomethacin (Indocin)
  • ketoprofen (Orudis, Ketoprofen ER, Oruvail, Actron)
  • etodolac (Lodine)
  • fenoprofen (Nalfon)
  • flurbiprofen
  • ketorolac (Toradol)
  • meclofenamate
  • mefenamic acid (Ponstel)
  • meloxicam (Mobic)
  • oxaprozin (Daypro)
  • sulindac (Clinoril)
  • salsalate (Disalcid, Amigesic, Marthritic, Salflex, Mono-Gesic, Anaflex, Salsitab)
  • tolmetin (Tolectin)

Diclofenac/misoprostol (Arthrotec)

Diclofenac/misoprostol is an oral drug that combines the NSAID diclofenac with misoprostol. NSAIDs can cause stomach ulcers. This drug helps prevent them.

Topical capsaicin (Capsin, Zostrix, Dolorac)

Capsaicin topical OTC cream may relieve mild pain caused by RA. You rub this cream on painful areas of your body.

Diclofenac sodium topical gel (Voltaren 1%)

Diclofenac sodium topical gel is an NSAID for topical use. It is used to treat RA and works by blocking substances that cause inflammation and pain.

Diclofenac sodium topical solution (Pennsaid 2%)

Diclofenac sodium (Pennsaid 2%) and 1.5% are topical solutions used for knee pain. You rub it on your knee to relieve pain.

Opioids are only available as prescriptions. They come in oral and injectable forms.

Since opioids can lead to dependence, they are only used for short periods of time, such as during a flare. If your doctor prescribes an opioid, they will monitor you closely.

Opioids include:

  • acetaminophen/codeine
  • codeine
  • fentanyl
  • hydrocodone (Vicodin)
  • hydromorphone
  • meperidine (Demerol)
  • methadone
  • morphine
  • oxycodone (OxyContin)
  • oxymorphone (Opana, Opana ER)
  • tramadol (Ultram)

Corticosteroids are also called steroids. They come as oral and injectable drugs.

These drugs can help reduce inflammation in RA. They may also help reduce the pain and damage caused by inflammation. These drugs aren’t recommended for long-term use.

Side effects can include:

  • high blood sugar
  • high blood pressure
  • emotional side effects, such as irritability and excitability
  • cataracts, or clouding of the lens in your eye
  • osteoporosis
  • skin changes, such as easy bruising and stretch marks

Steroids used for RA include:

  • betamethasone
  • cortisone
  • dexamethasone (Dexpak Taperpak, Decadron, Hexadrol)
  • hydrocortisone (Cortef, A-Hydrocort)
  • methylprednisolone (Medrol, Methacort, Depopred, Predacorten)
  • prednisolone
  • prednisone (Deltasone, Sterapred, Liquid Pred)

Immunosuppressants can help reduce the pain and inflammation from RA while also slowing joint tissue damage. However, these drugs can also make you more prone to illness and infection.

If your doctor prescribes one of these drugs, they’ll monitor you closely during treatment.

These drugs come in oral and injectable forms, like cyclophosphamide (Cytoxan).

It is important to talk to your doctor before starting any new treatments, even ones that are OTC. Your doctor will be able to find the RA treatment that works best for you with your individual needs in mind.

With so many options available, you and your doctor are likely to find one that eases your RA symptoms and improves your quality of life.